November 29, 2023

No health without housing

No health without housing

Swathes of sewage-contaminated houses left behind in the wake of Cyclone Gabrielle’s devastation show us that good housing and civil engineering have not kept pace with population. Today, Professor Philippa Howden-Chapman, Professor Nevil Pierse and Dr Brodie Fraser argue improving NZ’s housing stock is a critical policy issue that requires a multi-partisan approach.

People need warm, dry, safe, affordable housing that they have reason to value. We know such housing is a vital foundation of a healthy life. It provides security and privacy, the ability to make a home, a place where whānau and friends can comfortably visit, where children can be brought up in stable surroundings and older people can ‘age in place’.

With the market failing to deliver affordable, good quality, secure housing choices, those on low incomes and without family capital face high rents and increasing mortgage interest rates. As a direct result, most affordable, quality rental housing and first homes need to be provided or underwritten by central or local government, community trusts, iwi or hapū, using innovative models, such as co-housing or papakāinga. In this article we outline successes in this space, but also many areas where key gaps remain.

Read more in the Election 2023: Beyond the Soap Box series: Political shortsightedness exposes NZ to roulette of risk

Consider infrastructure. As the extraordinary floods and swathes of sewage-contaminated houses on Cyclone Gabrielle’s path have dramatically shown us, good housing and civil engineering have not kept pace with population. 

Extensive engineering is desperately needed in many parts of the country to repair stormwater, wastewater and freshwater pipes – many of which were built in the late 19th Century – and to increase capacity to deal with rapidly increasing climate change. There are regular overflows of sewage into Auckland and Wellington harbours resulting in beaches being red-stickered as unsuitable for swimming and fishing.

Many of the more densely populated parts of our country are on reclaimed wetlands, with high water tables or former light industrial areas, so require drainage, new pipes and the clean-up of contamination before houses can be safely built. These developments need to be well funded, coordinated and evaluated.

The location of housing in relation to community amenities, and green and blue spaces (which, by design, have doubled as sponges for floodwater in Hobsonville and Northcote) is critical to occupants feeling part of the existing community. This includes work and school being easily accessible by public transport, walking or cycling.

All these factors are known to increase people’s wellbeing and health.

Short-term corner-cutting is expensive in the long run. The public housing stock needs to be high quality and built to last. Crown entities such as Kāinga Ora – Homes and Communities need to keep thinking of long-term consequences irrespective of the government in power. Coming up to a national election, this is a critical policy issue and requires a consistent multi-partisan approach. 

We have high-quality public health and economic research in Aotearoa that clearly and repeatedly demonstrates the cost benefits of insulating, heating and ventilating homes and reducing household fall hazards. This research is recognised internationally in the WHO International housing and health guidelines. Well-funded implementation of these guidelines is critical for health and wellbeing and should ride above the political cycle.

Good systems planning is needed for effective collaboration across government, private and community agencies. The planning, design and construction of housing should be closely aligned with expected demographic changes, such as increasing migrant numbers, our ageing population and the increasing need for suitable housing for people with disabilities.

Over 2018 to 2022, a record number of houses were built, a total of 41,028 – 10,023 of which were permanent public houses. Kāinga Ora – Homes and Communities, which was set up in 2019, has assets of $38 billion and has clear ministerial instructions to build sustainable, good quality homes in areas close to amenities.

Kāinga Ora also has ministerial oversight to work closely with Māori and Pasifika, who suffer high rates of homelessness and declining rates of home ownership. Consequently, they are more likely to live in crowded households, which is the major risk factor for close-contact infectious diseases such as rheumatic fever and Covid-19.

Despite the scale of Kāinga Ora’s new builds and large-scale community regeneration, the housing system is now under considerable pressure, partly due to supply, but also the number of government organisations involved with different and sometimes conflicting institutional rules. Complicated funding and overlapping and unclear responsibilities lead to too many people struggling to find their way through the system to find a home.

Aside from Kāinga Ora, the Ministry of Housing and Urban Development now builds and manages transitional and emergency housing and manages the Homelessness Action Plan, which encourages shared responsibilities. However, this Action Plan, by which responsibility is explicitly shared, has allowed cracks between policies, which makes for stressful delays in rehousing people.

The Ministry of Social Development effectively holds responsibility for the Public Housing Waiting List and therefore determines how many public houses there can be and who will or will not receive Income-Related Rents. Finally, Te Puni Kōkiri decides which community organisations qualify as Māori organisations and therefore will be prioritised for their infrastructure funding. Suffice to say, this complex system needs a review. The public and the sector need clear pathways, clear responsibilities and one door for access to all services; so far this has remained an unrealised aspiration.

Evidence shows that cost of inaction in terms of people’s wellbeing is vastly greater than the costs involved in housing them. Housing First is a public health response to homelessness and severe housing deprivation, funded by the government but managed by community groups. Before being housed through Housing First, one cohort of 400 supposedly a “hard to reach population” had 200,000 interactions with government services.

We see a similar story with people unnecessarily confined in hospital and prisons. Often children and older people are not only hospitalised because of the poor conditions of their housing, but are more likely to be hospitalised again if they return to the houses that made them sick in the first place. Fixing up their houses, or rehousing them, can save money currently spent on inpatient care and more broadly increase their wellbeing. 

Similarly, people are often held on remand, or for prolonged stays in prison because there is a shortage of houses where they can be remanded or bailed. Total institutional care, whether in hospital or prison, is socially disruptive and expensive. Money spent on housing has a more positive impact on people’s lives than custodial care.

A longer version of this article appears on The Public Health Expert Briefing as part of a public health priorities series put out by the Public Health Communication Centre.

Professor Philippa Howden-Chapman and Professor Nevil Pierse are co-directors of He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington. Professor Howden-Chapman is also a Director on the Board of Kāinga Ora – Homes and Communities. The opinions here are her own and do not necessarily reflect Board policy.  

Dr Brodie Fraser is a Postdoctoral Research Fellow with He Kāinga Oranga/Housing and Health Research Programme, University of Otago, Wellington.

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